MEDICARE: MR. PAUL O CHURCH RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WH0200X	Home Health Registered Nurse	RN239290	OH
2	163W00000X	Registered Nurse	RN239290	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093731903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL O CHURCH RN

Provider Business Mailing Address
First Line	:	150 CROSS STREET
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44311-1026
Country	:	US
Telephone Number	:	330-996-9141
Fax Number	:	330-305-0815

Provider Business Practice Location Address
First Line	:	150 CROSS STREET
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44311-1026
Country	:	US
Telephone Number	:	330-996-9141
Fax Number	:	330-305-0815

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	02/24/2025

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